Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study

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BACKGROUND: Adjunctive dexamethasone increases survival from tuberculous meningitis, but the underlying mechanism is unclear. We aimed to determine the effect of dexamethasone on cerebral MRI changes and their association with intracerebral inflammatory responses and clinical outcome in adults treat...

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Auteur principal: Simmons, Cameron
Format: Journal Article
Langue:anglais
Publié: 2018
Accès en ligne:https://demo7.dspace.org/handle/123456789/48
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author Simmons, Cameron
author_browse Simmons, Cameron
author_facet Simmons, Cameron
author_sort Simmons, Cameron
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description BACKGROUND: Adjunctive dexamethasone increases survival from tuberculous meningitis, but the underlying mechanism is unclear. We aimed to determine the effect of dexamethasone on cerebral MRI changes and their association with intracerebral inflammatory responses and clinical outcome in adults treated for tuberculous meningitis. METHODS: Cerebral MRI was undertaken, when possible, at diagnosis and after 60 days and 270 days of treatment in adults with tuberculous meningitis admitted to two hospitals in Vietnam. Patients were randomly assigned either dexamethasone (n=24) or placebo (n=19) and received 9 months of treatment with standard first-line antituberculosis drugs. We assessed associations between MRI findings, treatment allocation, and resolution of fever, coma, cerebrospinal fluid inflammation, and neurological outcome. FINDINGS: 83 scans were done for 43 patients: 19 given placebo, 24 given dexamethasone. Basal meningeal enhancement (82%) and hydrocephalus (77%) were the most common presenting findings. Fewer patients had hydrocephalus after 60 days of treatment with dexamethasone than after placebo treatment (p=0.217). Tuberculomas developed in 74% of patients during treatment and in equal proportions in the treatment groups; they were associated with long-term fever, but not relapse or poor clinical outcome. The basal ganglia were the most common site of infarction; the proportion with infarction after 60 days was halved in the dexamethasone group (27%vs 58%, p=0.130). INTERPRETATION: Dexamethasone may affect outcome from tuberculous meningitis by reducing hydrocephalus and preventing infarction. The effect may have been under-estimated because the most severe patients could not be scanned.
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spelling oai:localhost:123456789-482021-04-07T16:30:07Z Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study Simmons, Cameron BACKGROUND: Adjunctive dexamethasone increases survival from tuberculous meningitis, but the underlying mechanism is unclear. We aimed to determine the effect of dexamethasone on cerebral MRI changes and their association with intracerebral inflammatory responses and clinical outcome in adults treated for tuberculous meningitis. METHODS: Cerebral MRI was undertaken, when possible, at diagnosis and after 60 days and 270 days of treatment in adults with tuberculous meningitis admitted to two hospitals in Vietnam. Patients were randomly assigned either dexamethasone (n=24) or placebo (n=19) and received 9 months of treatment with standard first-line antituberculosis drugs. We assessed associations between MRI findings, treatment allocation, and resolution of fever, coma, cerebrospinal fluid inflammation, and neurological outcome. FINDINGS: 83 scans were done for 43 patients: 19 given placebo, 24 given dexamethasone. Basal meningeal enhancement (82%) and hydrocephalus (77%) were the most common presenting findings. Fewer patients had hydrocephalus after 60 days of treatment with dexamethasone than after placebo treatment (p=0.217). Tuberculomas developed in 74% of patients during treatment and in equal proportions in the treatment groups; they were associated with long-term fever, but not relapse or poor clinical outcome. The basal ganglia were the most common site of infarction; the proportion with infarction after 60 days was halved in the dexamethasone group (27%vs 58%, p=0.130). INTERPRETATION: Dexamethasone may affect outcome from tuberculous meningitis by reducing hydrocephalus and preventing infarction. The effect may have been under-estimated because the most severe patients could not be scanned. 2018-09-14T11:10:08Z 2017-07-05T05:31:36Z 2018-09-14T11:10:08Z 2007-03-01 Journal Article https://demo7.dspace.org/handle/123456789/48 English
spellingShingle Simmons, Cameron
Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
title Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
title_full Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
title_fullStr Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
title_full_unstemmed Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
title_short Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
title_sort serial mri to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis an observational study
url https://demo7.dspace.org/handle/123456789/48
work_keys_str_mv AT simmonscameron serialmritodeterminetheeffectofdexamethasoneonthecerebralpathologyoftuberculousmeningitisanobservationalstudy

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